血清新喋呤水平对活动性肺结核的诊断价值研究  

Significance of serum neopterin level in diagnosis of active pulmonary tuberculosis

作　　者：石学萍[1,2] 齐曼古力.吾守尔 王泉 接力 

机构地区：[1]新疆医科大学第一附属医院呼吸一科,乌鲁木齐830054 [2]新疆维吾尔自治区胸科医院 [3]新疆维吾尔自治区胸科医院检验科,乌鲁木齐830049 [4]新疆维吾尔自治区胸科医院结核二科,乌鲁木齐830049

出　　处：《解放军医学杂志》2011年第10期1071-1073,共3页Medical Journal of Chinese People's Liberation Army

摘　　要：目的探讨血清新喋呤(Np)水平诊断活动性肺结核的敏感性和特异性。方法选择2009年4月-2010年5月连续入住新疆维吾尔自治区胸科医院结核科的肺结核患者,于入院次日清晨采血,酶联免疫吸附法(ELISA)检测血清Np水平,同时行卡介苗纯蛋白衍生物(PPD)皮试。结果共收集58例活动性、18例稳定型肺结核患者以及32名健康对照。活动性肺结核组Np值(54.14±19.85nmol/L)显著高于稳定型肺结核组(29.51±8.23nmol/L)和对照组(20.67±9.68nmol/L,P<0.01),而稳定性肺结核组与对照组间无统计学差异(P>0.05)。纤维空洞型肺结核的Np值(77.43±22.13nmol/L)显著高于浸润型肺结核(46.07±13.04nmol/L)及血行播散型肺结核(48.48±8.34nmol/L,P<0.01),而后两者间比较差异无统计学意义(P>0.05)。ROC曲线分析显示,以36.73nmol/L为临界值,血清Np值判断活动性肺结核的曲线下面积为0.951,其敏感性和特异性分别为86%和92%,均显著高于PPD试验的预测价值(分别为52%和78%,P<0.01)。结论血清Np值具有较高的敏感性和特异性,可作为活动性肺结核早期重要的辅助诊断指标。Objective To investigate the sensitivity and specificity of serum neopterin（Np） level in diagnosis of active pulmonary tuberculosis.Methods Patients with pulmonary tuberculosis,admitted to Xinjiang Chest Hospital from Apr.2009 to May 2010,were consecutively enrolled in present study.Serum neopterin level was determined with enzyme linked immunosorbent assay（ELISA） in the next morning of admission.VCG purified protein derivative test（PPD） was concurrently performed.Results Fifty-eight cases with active（group A） and 18 with stable（group S） pulmonary tuberculosis were recruited,and 32 healthy volunteers served as control（group C）.The mean Np level was significantly higher in group A（54.14±19.85 nmol/L） than in group S（29.51±8.23 nmol/L） and group C（20.67±9.68 nmol/L,P0.01）.No statistical difference was found between group S and group C（P0.05）.Among patients with active pulmonary tuberculosis,the mean Np level increased significantly in cases with the fibro-cavitative pulmonary tuberculosis（77.43±22.13）,compared with those cases with invasive（46.07±13.04） and hematogenous disseminated pulmonary tuberculosis（48.48±8.34 nmol/L,P0.01）,while no statistical difference existed between the latter two.The receiver operating characteristic（ROC） curve showed that the area under curve（AUC） was 0.951 in the cutoff value of 36.73 nmol/L,and the sensitivity and specificity were 86% and 92% for predicting active pulmonary tuberculosis,and it was significantly higher than PPD test（P0.01）,in which the sensitivity was 52% and specificity was 78%.Conclusions Np level may serve as one of the important adjunctive parameters for early diagnosis of active pulmonary tuberculosis due to its high sensitivity and specificity.

关 键 词：结核 肺 酶联免疫吸附测定 敏感性与特异性 

分 类 号：R521[医药卫生—内科学]